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Please print or type. (Form desioned for use on elite 112-nitrhl tvnPwrilar 1 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITYTO'DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21. Generator ID Number <br />22. Page <br />rune rppruveo. umn No. zubu-uujV <br />23. Manifest Tracking Number <br />(Continuation Sheet) <br />CA2890090002 <br />6 <br />05176--T:ri <br />A';% <br />24. Generator's Name -rern:e LwEF61C-1c r1= I?na+ L2---c-'ioryr --::c 'K0 <br />R.O Box 8081 L-786 <br />Lluerniore CA 94551 <br />25, Transporter Company Name <br />MAR 13 2017 <br />U.S. EPA ID Number <br />26. Transporter Company Name <br />U.S. EPA ID Number <br />ENTAL HE LTH <br />27a. <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />nP:MCR1F"ENj <br />29. Total <br />30. Unit <br />H61 <br />and Packing Group (if any)) <br />Quantity <br />YJt.Nol, <br />31. Waste Codes <br />No. <br />Type <br />45. Non-RCP.A hazardous waste, solid (rags contarrynated Mth <br />pet-oleum hydrocarbons) (DOP0044-1) <br />-`- <br />40. Nan-RCRA hazardous waste, solid (rags contaminated Wth <br />petroleum hydrocarbons)(ErOP0044-1) <br />222 <br />`- <br />3 <br />Dt. <br />36 <br />P <br />47. Nen-RCRA hazardous waste, solid (solidified silicone rubber, <br />grease) (DOP0120-1) <br />_ <br />71 <br />1 <br />DF <br />17 <br />0 <br />48. Non-RCRA hazardous waste, solid (spent caton) (DOP0085- <br />1) <br />,51 <br />1 <br />D11 <br />285 <br />P <br />w <br />49. Non-RCRA hazardous waste, solid (used oil filters) (DOP0044 <br />1) <br />1 <br />DF <br />9 <br />P <br />50. Dion-RCRA hazardous waste, solid (wipes and rags <br />352 <br />contaminated with ethylene glycol) P00044 -11)i <br />DM <br />51 <br />P <br />-� <br />51. Consumer cormlodity, ORM-D (aerosols) [ERG 171] <br />(DOP0112-1) <br />i <br />DF <br />7 <br />P <br />331 <br />52. Mste, Consumer commodity, ORM-D (aerosols) [ERG 17 1] <br />741 <br />(DOP0112-1) <br />1 <br />DF <br />63 <br />P <br />D001 <br />53. Waste, Consumer cofrnnodity, ORM-D (aerosols) [ERG 1711 <br />122 <br />(00P0112-1) <br />1 <br />DF <br />7 <br />PU00.. <br />2 <br />54 . N A'23Z N>��rra f✓)" Wc�, Ilc�. i6 i t1. �•5. <br />tIP00z), C1, , . mia vl (MPM-T-T--o <br />P <br />41 <br />► <br />m <br />�.�� <br />c�z <br />32 Special Handling Instructions and Additional Information <br />33. Transporter Aanowledgment of Receipt of Materials <br />LU I-- <br />PrintedJTyped Name Signature <br />Month Day Year <br />of <br />O <br />a <br />z <br />34. Transporter Acknowledgment of Receipt of Materials <br />Printed/Typed Name Signature <br />Month Day Year <br />r <br />r <br />35 Discrepancy <br />J <br />U <br />a <br />W <br />Q <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />z <br />N <br />W <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITYTO'DESTINATION STATE (IF REQUIRED) <br />